Page 67 - JSOM Fall 2019

a focus not only on skills but on decision-making as was sug- inability to bag-mask ventilate and intubate (Table 1). Next,
gested by Barnard et al. Eastridge and colleagues’ work also an educational session was provided to all participants which
6
suggests that “The most substantial, although not exclusive covered concepts such as bag-mask ventilation and placement
opportunity to improve these casualty outcomes, seems to of oral airways, placement of supraglottic airways, tracheal
be in the prehospital setting.” 5,7,8 A comprehensive review of intubation, and cricothyrotomy. A review of the Joint Trauma
mortality and morbidity from 2001 to 2011 found that 90% System Clinical Practice Guideline and a difficult airway algo-
of battlefield deaths occur in the prehospital setting, 24% of rithm were also included (Figure 4). After the lecture, partici-
5
which were potentially survivable; airway compromise is re- pants rotated through hands-on stations practicing bag-mask
sponsible for 8% of potentially survivable mortality and 1.6% ventilation, placement of supraglottic airways (i.e., i-gels),
of all battlefield deaths. 5,9 tracheal intubation, and cricothyrotomy. A certified registered
nurse anesthetist and a senior student nurse anesthetist were
Anesthesia providers are trained to manage an airway, and available to discuss techniques at each station. Effective bag-
they are often accessible by Army Reserve units in combat mask ventilation was defined by chest rise and appropriate
support hospitals or forward resuscitative surgical teams. In- tidal volumes able to be measured by the high-fidelity man-
terprofessional collaboration between these groups of provid- ikin. All participants used the same manikin, standardizing
ers shows promise for supplementing nonanesthesia provider’s that skill station. A simulation certified anesthesia provider
training in airway management. ran the simulations on the manikin. Following these rotations,
medics completed an identical “can’t intubate, can’t ventilate”
This project aims to answer the question: “among Army scenario to close the educational intervention. Researchers
Reserve combat medics, does education intervention from timed the participants to measure progression through the
anesthesia trained providers enable improved airway man- simulation and specific airway skills (Table 2). Last, partici-
agement?” Emphasis was placed on the management of the pants completed the postknowledge assessment and workshop
airway rather than individual skills. Self-appraisal by the par- evaluation for quality improvement.
ticipants was also explored. To address the need highlighted
by the literature, an airway education intervention was de- The pre/post knowledge assessment and surveys measured the
5–8
veloped, implemented, and evaluated as a potential mitigation following: airway algorithm, airway anatomy, airway assess-
strategy for the prevention of prehospital deaths. ment, skill technique, and tools to aid in prediction of dif-
ficulty (Figure 1) and comfort with performing airway skills
respectively (Figure 2). The performance evaluation tool
Methods
(Figure 3) measured the following parameters: technique and
Institutional review board approval was sought for this proj- time to effective mask ventilation (chest rise, mist in mask)
ect through the affiliated university and subsequently deemed or recognition that mask ventilation was ineffective, tracheal
nonhuman subject research and exempt from oversight intubation, supraglottic airway (SGA) insertion, and cricothy-
requirements. rotomy (Tables 1 and 2). At the conclusion, a workshop eval-
uation survey was used to collect qualitative data for quality
Ten Army Reserve combat medics were recruited to partic- improvement of the project.
ipate voluntarily and unpaid in an education intervention
developed to investigate the potential effectiveness of improv- Results
ing airway management. Participants ranged from having no
airway experience outside their initial military occupational Data were collected using the evaluation tools described. A
specialty (MOS) training to 17 years in the military with some Wilcoxon signed-rank test was used with SPSS to demonstrate
airway experience during deployments. Some had a healthcare statistical significance for paired data. Self-reported comfort
background, but many did not. Most had never instrumented levels with airway skills following the workshop (Mdn = 5.38)
an airway (i.e. placed an airway such as a sub or supraglottic were significantly higher than baseline (Mdn = 3.61) among
device). the 10 participants (z = –2.803, p = .005). Post workshop
comfort levels with progressing through the airway manage-
The airway simulation workshop took place in a university ment algorithms (Mdn = 6.2) were significantly higher than
simulation lab. The Army Reserve combat medic participants, the baseline (Mdn = 3.7) (z = –2.807, p = .005). Post workshop
along with an Army nurse corps officer and the respective comfort levels with identification of difficulty with airway in-
unit’s combat medic simulation sustainment training coordi- terventions (Mdn = 5.8) were significantly higher than base-
nator, attended the workshop. A preknowledge assessment line (Mdn = 3.6) (z = –2.809, p = 0.005).
was administered to evaluate baseline, applied knowledge
before the workshop began (Figure 1). Participant’s comfort Knowledge Assessment
levels with basic airway management and skills were also sur- Scores improved demonstrating the attainment of new knowl-
veyed using a Likert scale (Figure 2). Once completed, partic- edge and the reinforcement of previously acquired knowledge
ipants were cycled through a simulation scenario in which a from initial training. None of the participants had knowledge
high-fidelity manikin was unable to be ventilated or intubated. of the existence of a clinical practice guideline for airway man-
Researchers evaluated the participants using a performance agement of a trauma patient. Similarly, none were able to rec-
evaluation tool (Figure 3) to measure progression through the ognize the function of a basic airway algorithm prior to the
simulation and specific airway skills (Table 1). Participants intervention.
were timed by one researcher on one high fidelity manikin to
maintain consistency. The scenario progression followed the Performance Evaluation
Joint Trauma System Clinical Practice Guideline (Figure 4) The Army Reserve combat medics functioned with a higher
taking participants through an exercise which illustrated an level of efficiency during the high-fidelity simulation after the

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